Provider Demographics
NPI:1841795747
Name:GOMEZ PADRON, MARIA VIRGINIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VIRGINIA
Last Name:GOMEZ PADRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15071 SW 49TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3600
Mailing Address - Country:US
Mailing Address - Phone:786-200-1270
Mailing Address - Fax:
Practice Address - Street 1:4767 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2933
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:305-627-3862
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1097208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice